What does the future hold for the population health management concept? The present moment in U.S. healthcare is filled with both challenge and opportunity in this absolutely critical area of endeavor. On the one hand, the population health idea has taken off as it has never before. It is embedded in virtually all the main policy initiatives coming out of all the major public and private purchasers and payers of healthcare, whether in some of the mandates coming out of the Affordable Care Act (ACA), or embedded in the value-based purchasing (VBP) initiatives coming out of the federal Centers for Medicare and Medicaid Services (CMS) for the Medicare program, or from nearly any of the major VBP programs sponsored by virtually all of the major U.S. health plans.
Yet the reality of the moment is that, despite all the policy incentives forcing providers to begin to take action, most patient care organizations are still in the very early stages in terms of leveraging healthcare IT and data to support and facilitate population health. Indeed, on the journey of 1,000 miles, most industry observers agree that we are in the first steps of that journey.
Not surprisingly, mixed sentiments were on display among the industry leaders participating in the 15th annual Population Health Colloquium, held on March 23 at the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia, and chaired by David Nash, M.D., dean of the Jefferson School of Population Health.
“I expect us to talk more about data [in the next couple of years], because I think people are going to be drowning in data,” said Drew Harris, director of the Jefferson School of Population Health. “We are generating so much data that the question is, are we going to be able to turn that data into knowledge and actionable intelligence? We need to have new systems in place to better help clinicians use the data so they can figure out what to do with that Fitbit on somebody’s wrist or the Apple Watch that folks are going to expect somebody to help them analyze.” He also urged fellow participants to focus on patient engagement to make population health become truly successful.
Still, Brian Silverstein, M.D., president of HC Wisdom, a Glencoe, Ill.-based consulting firm, cautioned attendees that, “While I would like to be optimistic, I think next year is going to be tough. We are either going to be schizophrenic or bipolar. I am not sure which one. There is such great work going on and people are going to be aware that it is possible to do things to deliver better care at a lower cost. But some organizations are going to be entrenched in something and not getting results, so there is going to be an increasing level of frustration.”
In that context, said Mark Wagar, president of the Northridge, Calif.-based Heritage Provider Network, which encompasses more than 30,000 physicians in several states, “Sorting and stratify data to focus on a population doesn’t require perfect data. If you are waiting for someone from a big data company to come in and produce it all at once, it is not going to happen. We have 30,000 independent physicians. They are not all on one EMR, and are not going to be anytime soon, and we have patients to serve in the meantime. We have created some off-the-shelf systems combined with some proprietary systems where we can cross-match and collect as much data as possible,” he noted.
Making the Health IT Connection
That discussion in March at Thomas Jefferson University mirrors countless discussions around policy, strategy, process, and tactics taking place these days. Within the broader context of the push towards population health, industry leaders agree that the healthcare IT needed to facilitate pop health is just now being implemented, and is being implemented very unevenly at that.
For example, says Charles Kennedy, M.D., chief population officer at Healthagen LLC, a subsidiary of the Hartford, Conn.-based Aetna, and a health insurer executive helping to guide dozens of accountable care organizations (ACOs), “Health IT systems which offer the equivalent of a clinical navigation system are woefully under-deployed. Achieving the required information state requires a new HIT infrastructure, supporting integrated administrative, claims and clinical data from all sources reorganized and optimized to assist with value-based care interventions for each individual’s health and care. These records must be not only semantically interoperable, but must also be structured in such a way that provides useful and usable information on each individual patient,” he urges. “Today, however, many EMRs function like electronic file cabinets. “
The key to successfully leveraging health IT for population health management, says Judy Murphy, R.N., is that “The success is not just in the measurement and analytics, but in the ability to impact the health of populations. It’s leveraging the health IT for actual care coordination.” In October 2014, Murphy became chief nursing officer and director, Global Business Services, at IBM Healthcare. Prior to that, she had been chief nursing officer and director of the Office of Clinical Quality and Safety in the Office of the National Coordinator for Health IT (ONC). On a practical level, Murphy says, “It all starts with capturing the correct data in a data warehouse. And 80 percent of healthcare data today is not structured. So they either have to structure it or run it through natural language processing, or Watson.”
What should CIOs and other senior healthcare IT leaders be thinking about as their organizations begin to pursue population health? “They need to be thinking about what is involved in information-sharing with the post-acute world,” says Charles E. “Chuck” Christian, vice president and CIO at St. Francis Hospital in Columbus, Georgia, and the current chair of the board of the College of Healthcare Information Management Executives (CHIME). “There are a lot of new post-acute care settings we need to think about. Part of the problem,” he notes, “is that some post-acute providers, especially nursing homes, haven’t fully automated yet; but we’re getting there. And we’re developing data sets. So it’s a symbiosis: we’re helping nursing homes and other post-acute providers to help us. If we can appropriately transition the patient to their level of care, that is what’s important.”